Self-Referral to Hospital? No Thanks!

I’ve had terminal cancer five or six times in my life, all cured by the same remedy – a swift visit to my GP. I scare myself quite easily, you see – a consequence of a very real life-threatening diagnosis I was given in my mid-20s which involved months of investigations and eight hours of major surgery.

I don’t need strong medication, just the most potent treatment a GP can dispense – reassurance: dosage variable; take when necessary. My GP understands. He says he sees this all the time.

Put any three symptoms into Google and you’ll discover you’ve only got a few weeks to live. He invariably takes me seriously because, he says, there’s always a tiny chance I might be right, and letting me pour out my worries beneath his gentle laying on of hands is all part of the iatrical magic.

But my GP is no Mother Teresa. In fact, he let me down quite badly two years ago when he went on holiday for a fortnight just as the first signs of malignancy struck. Knowing that he would return only just in time to sign my death certificate, I did what any sensible person would do: I pitched up in A&E.

The young doctor who saw me there was equally kind and attentive, and he confirmed my worst fears; that my symptoms might just be the sign of something serious. So he ordered four separate tests, which took some three weeks to complete.

One was particularly unpleasant, and I missed two days of work as a consequence. An anxiety-provoking visit to my GP was required to get the results. He smiled, raised an eyebrow, and sighed: “My, you have been busy, haven’t you?”

And I had. And yes, you guessed it, all was fine. But surely it was a close call? After all, I’d needed all those tests and expended weeks on worry. Not so, it seems. My GP explained the fundamental difference between General Practice and Hospital Practice, which is essentially that if four different tests are possibly indicated for a given set of symptoms, then the hospital will perform all four.

A GP, however, based on previous experience and knowledge of the patient, will organise perhaps one or two, saving three and four for a later date depending on the results of the first one or two.

General Practice, you see, is half science and half art, tailoring the investigation of each patient to their particular circumstances; not performing all tests on all people at the same time at huge expense, in the – often vain – hope that one might confirm something suspected.

My GP calls it Risk Assessment and claims, probably correctly, that if he sent all of his patients off for “the full works” then the NHS would collapse within a month. He can’t claim to make the right call 100% of the time, but assures me that an experienced GP will rarely mess up, and, of course, hospital doctors aren’t infallible either.

This is why GPs are called the “gatekeepers” of the NHS. They rationally work out who needs what treatment and when, thereby preventing the expensive and ever-expansive, inefficient free-for-all that some other country’s healthcare systems represent. And that is a major part of the reason that the NHS is the envy of the world, providing pretty good bangs for the proportionately few bucks we put in.

But hey, here’s a great idea. Let’s get rid of the gatekeepers so that anyone with symptoms that might possibly signify cancer can refer themselves straight to hospital for “the full works”. That will unquestionably increase the diagnosis rate to some extent, but at what cost? And that cost must be measured both in financial terms as well as any impediment inflicted on the truly sick by flooding the system with the worried well.

Believe it or not, this is the latest plan from NHS England. I can’t quite see it working out, but why not spend a few dozen million pounds giving it a try? My GP’s in favour of it. He says his working day will be just a little bit quieter.

Me, I’ll now be able to trundle off to A&E whenever I can’t get an appointment for an injection of GP reassurance. I just hope that my cancer symptoms will abate in hospital as painlessly as they do in the local surgery.